【持续性肾脏替代治疗CRRT英文ppt课件Lactic Acidosis.ppt

Lactic Acidosis;? Arterial (or serum) Lactate > 5 mmol/L ? Arterial (or serum) pH < 7.35 (or base deficit > 6 mmol/L) ? Anion gap : insensitive ; Arterial pH< 7.25 Corresponding lactate level> 5 mmol/L *Lactate level> 9 mmol/L : high mortality rate(>75%);Pathophysiology of Lactic Acid Metabolism;Chemical structures of L-lactic acid and D-lactic acid;Chemical structures of lactic acid and the sodium salt of lactate;A summary of the physical properties of lactic acid;Glucose ; 1. This reversible reaction occurs in the cytosole. 2. Catalyzed by the enzyme lactate dehydrogenase (LDH) 3. Lactate is a metabolic end-product, its only metabolic fate being oxidation back to pyruvate. 4. The equilibrium of equation favors the formation of lactate. 5. Under normal conditions, the concentration of lactate is a 4 to 10 times greater than that of pyruvate. 6. LDH is stereospecific for the L(+)-lactate reaction. 7. L(+)-lactate is the natural forms in mammals.; 1. Pyruvate concentration 2. NADH/NAD+ ratio 3. [H+] concentration ;;1. Redox state of the cytosolic pyridine nucleotides 2. The ratio is affected by various cytosolic dehydrogenase. 3. Mitochondria-containig cells : NADH is oxidized to NAD+ by the electron transfer chains 4. Suppression of mitochondrial function reduced availability of NAD+ within cytosol. ? increase [NADH] / [NAD+] ratio ? ? lactate production;Intracellular Hydrogen Ion;1. Major lactate-consuming organs: liver and renal cortex 2. Fractional contribution to the total basal lactate load: Liver ; 50-60%, kidney ; 20-30% 3. Two pathways of lactate consumption: - Liver; Gluconeogenesis is the primary mode of lactate. - Kidney; About 50% of lactate uptake is oxidation and gluconeogenesis. (renal excretion: minor role);Lactic acid-producing and -consuming Tissues Under Basal Conditions;Synopsis of Acid-base Effects on Lactate Metabolism;? LA i